Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio index (APRI): Usefulness in patients with chronic liver disease

Background: the aspartate aminotransferases (ast) to platelet ratio index (apri) may serve as a noninvasive marker to assess liver fibrosis.objectives: to assess the diagnostic ability of the apri for prediction of fibrosis in patients with chronic hepatitis b (chb), chronic hepatitis c (chc), and non-alcoholic fatty liver disease(nafld).patients and methods: this retrospective study included 207 patients with chb, 108 with chc, and 140 patients with nafld. the apri was calculated as (ast level/upper normal limit for ast)/platelet counts (109/l) × 100. the stage of liver fibrosis in patients with chronic viral hepatitis was graded using the metavir scale. the kleiner system for grading fibrosis was used in patients with nafld.results: bivariate correlation analyses showed that the apri was significantly associated with fibrosis scores in patients with chc (p = 0.2634, p = 0.0059) and nafld (p = 0.2273, p = 0.0069), but not in those with chb (p = 0.1005, p = 0.1495). receiver operating characteristic(roc) curves were used for assessing the ability of the apri as a predictor of the absence or presence of liver fibrosis (fibrosis score of 0 vs fibrosis scores of 1-4). in patients with chc, the apri showed a sensitivity of 72.7% and a specificity of 62.4% for detection of fibrosis (p<0.01). in the nafld group, the apri showed a sensitivity of 60.0% and specificity of 73.3% for detection of fibrosis (p<0.01). in patients with chb, the apri showed a sensitivity of 55.0% and a specificity of 75.4% for fibrosis (p=ns).conclusions: the apri shows an acceptable accuracy for the assessment of liver fibrosis in patients with chc and nafld, but not in those with chb.